3.1.2. Physiotherapy treatment
3.1.2.1. Early ambulation and rehabilitation
Early ambulation and rehabilitation have been extensively researched after both elective
abdominal surgery and after critical illness. There is an increasingly compelling body of
evidence that physical activity 1–2 times per day for up to 15–30 min is both safe and efficacious
for critically ill patients [47]. Early mobilisation has been shown to decrease ICU and hospital
length of stay, reduce the effect of ICUAW and improve quality of life [48]. Early mobilisation
in the critically ill should be undertaken under highly controlled circumstances and such
decisions are made according to individual patient status and haemodynamic stability.
Evidence shows that adverse events occur in only a small number of patients (1–4%) [47, 49–
52]. A recent systematic review reported no serious adverse medical consequences whilst
mobilising critically ill patients in 14 of 15 trials [53].
Enhanced Recovery After Surgery (ERAS) protocols exist to inform peri-operative manage‐
ment of specific elective abdominal surgeries. Such protocols contain recommendations
regarding, amongst other interventions, the importance of early ambulation after abdominal
surgery, specifying the frequency and duration required to be undertaken. For example, for
patients undergoing elective rectal or pelvic surgery the guidelines recommend they are
nursed in an environment encouraging independence and mobilisation with two hours out of
bed on the day of surgery and six hours out of bed each day thereafter [54]. A further example
includes patients following elective pancreaticoduodenectomy and states such patients should
be actively mobilised from the morning of the first post-operative day, with mobilisation
targets to be met each day [55]. Regardless of specific protocols, there is general consensus that
to counteract the deleterious effects of immobility following any abdominal surgery patients
should be mobilised early and often [54–58].
3.1.2.2. Respiratory physiotherapy
Whilst DB&C exercises to clear secretions have previously been considered essential in
physiotherapy programmes following abdominal surgery [46], there has been no convincing
evidence showing them to be any more effective in reducing PPC incidence than providing
frequent early intensive ambulation alone [59]. As a result, recent research has focussed on the
effectiveness of providing early ambulation alone in preventing post-operative complications
[46]. Following emergency UAS, some patients may be unable to ambulate due to, for example,
haemodynamic instability or traumatic injury, and thus, the inclusion of DB&C should be
considered to be of value after emergency UAS [46]. If sputum retention occurs post-opera‐
tively, DB&C can also be augmented using additional techniques such as positive expiratory
pressure (PEP) therapies. Such devices have been purported to aid in improving lung volumes
and secretion clearance although a systematic review concluded that PEP conveys no addi‐
tional benefit over other respiratory techniques [60]. These findings were limited by the poor
quality of studies and small samples sizes within the review. However, since this systematic
review, a well-designed randomised controlled trial (RCT) has found that an oscillating PEP
device reduced days of fever and LOS [61] following elective UAS and thoracic surgery.
Physiotherapy Following Emergency Abdominal Surgery
http://dx.doi.org/10.5772/63969115